<include file="Public:header" />
<include file="Public:mainNavBar" />
<include file="Public:sidebar" />


<div id="wrapper" class="wat-cf">
	<div id="main">
		<div class="block" id="agencyForm">
      <div class="content">
        <h2 class="title">Agency Form</h2>
        <div class="inner">
          <form id="form1" action="/Admin/Agency/doAdd" method="post" class="form">
            <input type='hidden' id='agencyId' name='agencyId'>
            <div class="group">
              <label class="label">Email</label>
              <input type="text" class="text_field" id='email' name='email'/>
              <span class="description">Ex: xxx@xxx.com</span>
            </div>
            
            <div class="group">
              <div class="fieldWithErrors">
                <label class="label" for="post_title">Name</label>
              </div>
              <input type="text" class="text_field" id='name' name='name' />
              <span class="description">Ex: a simple text</span>
            </div>
            <div class="group">
              <div class="fieldWithErrors">
                <label class="label" for="post_title">password</label>
              </div>
              <input type="text" class="text_field" id='password' name='password' />
            </div>
			<div class="group">
              <div class="fieldWithErrors">
                <label class="label" for="post_title">Road name</label>
              </div>
              <input type="text" class="text_field" id='road_name' name='road_name'/>
            </div>
            <!-- 
            <div class="group">
              <div class="fieldWithErrors">
                <label class="label" for="post_title">Road number</label>
              </div>
              <input type="text" class="text_field" id='road_number' name='road_number'/>
            </div>
            <div class="group">
              <div class="fieldWithErrors">
                <label class="label" for="post_title">Road Description</label>
              </div>
              <input type="text" class="text_field" id='road_desc' name='road_desc'/>
            </div>
             -->
            <div class="group">
              <div class="fieldWithErrors">
                <label class="label" for="post_title">City</label>
              </div>
              <input type="text" class="text_field" id='city' name='city'/>
            </div>
            <div class="group">
              <div class="fieldWithErrors">
                <label class="label" for="post_title">Postcode</label>
              </div>
              <input type="text" class="text_field" id='postcode' name='postcode'/>
            </div>
            <div class="group">
              <div class="fieldWithErrors">
                <label class="label" for="post_title">Phone</label>
              </div>
              <input type="text" class="text_field" id='phone' name='phone'/>
            </div>
            
            <div class="group">
                  <div class="fieldWithErrors">
                    <label class="label" for="post_title">Confirmed</label>
                  </div>
                  <select id='confirmid' name='confirmid'>
                  	<option value='1'>confirmed</option>
                  	<option value='0'>unconfirmed</option>
                  </select>
                </div>
                
                <div class="group">
                  <div class="fieldWithErrors">
                    <label class="label" for="post_title">Status</label>
                  </div>
                  <select id='statusid' name='statusid'>
                  	<option value='0'>delete</option>
                  	<option value='1'>normal</option>
                  </select>
                </div>
            
            <script>
			var thumbPrefix = 'logo_w200_w200_';
			var thumbW = 200;
			var thumbH = 200;
			</script>
            <include file="Public:uploadImg" />
         </div>
      </div>
      
      <div class="content">  
          	  <h2 class="title">Contact</h2>    
              <div class="inner form">
                <div class="group">
                  <div class="fieldWithErrors">
                    <label class="label" for="post_title">Firstname</label>
                  </div>
                  <input type="text" class="text_field" id='firstname' name='firstname'/>
                </div>
                <div class="group">
                  <div class="fieldWithErrors">
                    <label class="label" for="post_title">Lastname</label>
                  </div>
                  <input type="text" class="text_field" id='lastname' name='lastname'/>
                </div>
                <div class="group">
                  <div class="fieldWithErrors">
                    <label class="label" for="post_title">Contact Phone</label>
                  </div>
                  <input type="text" class="text_field" id='contactPhone' name='contactPhone'/>
                </div>
                <div class="group">
                  <div class="fieldWithErrors">
                    <label class="label" for="post_title">Contact Email</label>
                  </div>
                  <input type="text" class="text_field" id='contactEmail' name='contactEmail'/>
                </div>
                <div class="group navform wat-cf">
                  <button class="button" type="submit">
                    <img src="../Public/images/icons/tick.png" alt="Save" /> Save
                  </button>
                  <span class="text_button_padding">or</span>
                  <a class="text_button_padding link_button" href="javascript:cancel();" >Cancel</a>
                </div>
              </form>
            </div>
          </div>
        </div>
		<include file="Public:message" />
	</div>
</div>
<include file="Public:footer" />